A systematic review of determinants of psychosocial health outcomes of stroke survivors in low and middle income countries

Psychosocial consequences of stroke are frequently undiagnosed and untreated among stroke survivors (SSVs) in low- and middle-income countries (LMICs). Understanding the determinants of these psychosocial health outcomes may guide intervention choices and recovery expectations. The aim of this systematic review was to synthesise the main determinants of psychosocial health outcomes of SSVs in LMICs. The systematic review followed the Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered on PROSPERO (CRD42025629244). A comprehensive literature search was conducted using EBSCOhost, Scopus, and Web of Science databases for studies published from inception until 2025. Inclusion criteria focused on original research on SSV in LMICs. Newcastle–Ottawa Scale was used to determine methodological quality. Data was analysed using a narrative synthesis. A total of 979 articles were identified, and only 52 studies met the inclusion criteria. Of these studies, 42 involved patients with different types of strokes, 9 were on ischaemic stroke, while only one was on haemorrhagic stroke. Thirty-four (34) studies investigated a combination of factors, 7 studies identified psychosocial factors, while another 7 identified clinical factors as psychosocial determinants of health outcomes SSVs. Of the eligible studies, 36 were classified as having low risk of bias, 15 had moderate risk of bias, while the remaining two had high risk of bias. The main determinants of psychosocial health outcomes overlap as clinical factors, including stroke severity ( n = 15), and functional status ( n = 14); psychosocial factors including socioeconomic and sociodemographic factors ( n = 28), social support ( n = 11), anxiety, depression, cognitive impairment and quality of life domains ( n = 9). The determinants of psychosocial health outcomes among SSVs in LMIC are of multiple interrelated factors, including clinical, psychological factors, psychiatric conditions personality disorders, cognitive impairments, social determinants of health and nutritional status. Understanding these determinants may guide intervention decisions and recovery expectations, thereby alleviating the significant burden associated with stroke in LMICs.